Pregnancy and perinatal outcomes in women with recurrent pregnancy loss—A case–control study

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2024-12-22 DOI:10.1111/aogs.15039

Hanna Hautamäki, Mika Gissler, Jenni Heikkinen-Eloranta, Aila Tiitinen, Pirkko Peuranpää

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引用次数: 0

Abstract

Introduction

Recurrent pregnancy loss (RPL), defined as two or more pregnancy losses, might be associated with elevated obstetrical and perinatal risks in the following pregnancies. RPL and pregnancy problems related to placental development may have similar etiological features. This study explores the incidences of pregnancy and perinatal outcomes in women with RPL.

Material and Methods

This retrospective case–control study investigated the outcomes of the next subsequent singleton pregnancy after thorough RPL examination (n = 360) in Helsinki University Hospital, Finland, in 2007–2016. Data for cases and four control women for each case, matched for age, parity, delivery month, year, and hospital (n = 1440), were retrieved from the Medical Birth Register. Primary outcomes were pregnancy and delivery complications, perinatal outcomes, and characteristics of pregnancy follow-up. Secondary outcomes were maternal and neonatal diagnoses. Associations between RPL and outcomes were estimated with risk ratios with 95% confidence intervals (CI). In sub-analyses, we compared the outcomes of secondary RPL with multipara controls and women with unexplained or explained RPL.

Results

Women with RPL had a higher risk for gestational hypertension (3.1% vs. 1.4%, risk ratio [RR] 2.20 [Confidence interval (CI) 1.06–4.55], p = 0.03), preterm birth (8.9% vs. 5.8%, RR 1.54 [CI 1.04–2.28], p = 0.04), malpresentation of the fetus (3.3% vs. 1.5%, RR 2.18 [CI 1.09–4.37], p = 0.02), premature rupture of membranes (5.6% vs. 2.4%, RR 2.35 [CI 1.37–4.04], p = 0.002), and had more prenatal visits than controls. Mode of delivery was comparable between the study groups, although RPL women had more induced labor (28.1% vs. 22.2%, RR 1.26 [CI 1.04–1.53], p = 0.02). Mean birthweight was lower (3387 ± 680 g) in RPL women's newborns than in the control group (3482 ± 564 g, p = 0.02), and the risk of umbilical artery pH <7.10 (6.7% vs. 3.6%, RR 1.85 [CI 1.15–2.95], p = 0.03) was higher. Risk ratio for small for gestational age was higher in the secondary RPL group than in multipara controls (5.1% vs. 2.0%, RR 2.50 [CI 1.15–5.42], p = 0.02).

Conclusions

Women with a history of RPL seem to have higher risks in their subsequent pregnancies and should therefore be monitored carefully. These findings support the theory of placental development being the common nominator behind hypertensive pregnancy disorders and RPL.

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复发性流产妇女的妊娠和围产期结局——一项病例对照研究

复发性妊娠丢失（RPL），定义为两次或两次以上妊娠丢失，可能与后续妊娠的产科和围产期风险升高有关。RPL和与胎盘发育有关的妊娠问题可能具有相似的病因学特征。本研究探讨了RPL妇女的妊娠发生率和围产期结局。材料和方法：本回顾性病例对照研究调查了2007-2016年在芬兰赫尔辛基大学医院进行RPL检查后的下一次单胎妊娠结局（n = 360）。病例和每个病例的四名对照妇女的数据，匹配年龄、胎次、分娩月份、年份和医院（n = 1440），从医学出生登记册中检索。主要结局是妊娠和分娩并发症、围产期结局和妊娠随访特征。次要结局是产妇和新生儿的诊断。RPL与结果之间的关联用95%可信区间（CI）的风险比进行估计。在亚分析中，我们比较了继发性RPL与多段对照和不明原因或解释性RPL妇女的结果。结果：RPL患者发生妊娠期高血压（3.1%比1.4%，风险比[RR] 2.20[置信区间（CI） 1.06-4.55], p = 0.03）、早产（8.9%比5.8%,RR 1.54 [CI 1.04-2.28], p = 0.04）、胎儿胎位不良（3.3%比1.5%,RR 2.18 [CI 1.09-4.37], p = 0.02）、胎膜早破（5.6%比2.4%,RR 2.35 [CI 1.37-4.04], p = 0.002）的风险较高，且产前就诊次数多于对照组。虽然RPL妇女有更多的引产（28.1%比22.2%,RR 1.26 [CI 1.04-1.53], p = 0.02），但各研究组之间的分娩方式具有可比性。RPL组新生儿的平均出生体重（3387±680 g）低于对照组（3482±564 g, p = 0.02），且脐动脉pH风险较高。结论：有RPL病史的妇女在随后的妊娠中似乎有更高的风险，因此应仔细监测。这些发现支持胎盘发育是高血压妊娠障碍和RPL背后的共同推手的理论。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Obstetricia et Gynecologica Scandinavica 医学-妇产科学

CiteScore

8.00

自引率

4.70%

发文量

180

审稿时长

3-6 weeks

期刊介绍： Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.